Treating Nail Fungus with Oral Meds or Confirmatory Testing: Which is Cheaper?

New research has found that performing confirmatory diagnostic tests before treating nail fungus (onychomycosis) with topical medicine efinaconazole is significantly more cost effective.

To compare three different approaches for diagnosing and treating nail fungus, Arash Mostaghini, MD, MPA, Brigham and Women’s Hospital, Boston, MA, and team conducted an analysis published in JAMA Dermatology based on data from previously published literature.

Mostaghini found that the calculated costs of treatment and monitoring liver enzymes linked to a 12-week course of oral medication terbinafine for one patient was $53 and a full course of efinaconazole therapy for just one nail was $2,307.

Whereas, it simply cost $6 to conduct confirmatory tests using potassium hydroxide (KOH) and $148 for periodic acid-Schiff (PAS) testing.

According to the Clinical and Research Information on Drug-Induced Liver Injury Database, the overall combined costs to avoid liver injury with terbinafine with a disease prevalence of 75% was between $18.2 million and $43.7 million when using KOH screening and between $37.6 million and $90.2 million for PAS testing.

However, performing confirmatory testing prior to treatment with efinaconazole showed a savings of $272 and $406 per patient per nail even when using KOH and PAS screening and testing.